MEDICARE: DR. ALICE JO SIEGEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	135-323-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3357198	OTHER	NY	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700954807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE JO SIEGEL MD

Provider Business Mailing Address
First Line	:	119 EAST 83RD STREET
Second Line	:	APT 1A
City	:	NEW YORK CITY
State	:	NY
Zip	:	10028
Country	:	US
Telephone Number	:	212-831-8403
Fax Number	:	914-381-4157

Provider Business Practice Location Address
First Line	:	119 EAST 83RD STREET
Second Line	:	APT 1A
City	:	NEW YORK CITY
State	:	NY
Zip	:	10028
Country	:	US
Telephone Number	:	212-831-8403
Fax Number	:	914-381-4157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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